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Flax V.L.,University of North Carolina at Chapel Hill | Siega-Riz A.M.,University of North Carolina at Chapel Hill | Reinhart G.A.,The Mathile Institute for the Advancement of Human Nutrition | Bentley M.E.,University of North Carolina at Chapel Hill
Maternal and Child Nutrition

Inadequate energy intake and poor diet quality are important causes of chronic child undernutrition. Strategies for improving diet quality using lipid-based nutrient supplements (LNS) are currently being tested in several countries. To date, information on children's dietary intakes during LNS use is available only from Africa. In this study, we collected 24-h dietary recalls at baseline, 3, 6, 9 and 12 months on Honduran children (n=298) participating in a cluster-randomised trial of LNS. Generalised estimating equations were used to examine differences in number of servings of 12 food groups in the LNS and control arms, and multi-level mixed effects models were used to compare macro- and micronutrient intakes. Models accounted for clustering and adjusted for child's age, season and breastfeeding status. Mean daily servings of 12 food groups did not differ by study arm at baseline and remained similar throughout the study with the exception of groups that were partially or entirely supplied by LNS (nuts and nut butters, fats, and sweets). Baseline intakes of energy, fat, carbohydrates, protein, folate and vitamin A, but not vitamin B12, iron and zinc were lower in the LNS than control arm. The change in all macro- and micronutrients from baseline to each study visit was larger for the LNS arm than the control, except for carbohydrates from baseline to 9 months. These findings indicate that LNS improved the macro- and micronutrient intakes of young non-malnourished Honduran children without replacing other foods in their diet. © 2015 John Wiley & Sons, Ltd. Source

Ramakrishnan U.,Emory University | Nguyen P.H.,Thai Nguyen University | Gonzalez-Casanova I.,Emory University | Pham H.,Thai Nguyen University | And 8 more authors.
Journal of Nutrition

Background: Maternal nutritional status before and during early pregnancy plays a critical role in fetal growth and development. The benefits of periconception folic acid (FA) supplementation in the prevention of neural tube defects is well recognized, but the evidence for preconception micronutrient interventions for improving pregnancy outcomes is limited. Objective: This study aimed to evaluate whether preconception supplementation with weekly iron and folic acid (IFA) or multiple micronutrients (MMs) improves birth outcomes compared with FA alone. Methods: We recruited 5011 women of reproductive age in a double-blind, randomized controlled trial in Vietnam and provided weekly supplements containing either 2800 μg FA, 60 mg Fe and 2800 μg FA (IFA), or the same amount of FA and iron plus other MMs until they conceived (n = 1813). All pregnant women received daily IFA through delivery, and were followed up for birth outcomes, including birth weight, gestational age, preterm delivery and small for gestational age (SGA). Group comparisons were done with the use of ANOVA or chi-square tests for both intention-to-treat (n = 1599) and per-protocol analyses (women consumed supplements ≥26 wk before conception; n = 824). Effect modification by baseline underweight or anemia status was tested with the use of generalized linear models. Results: The mean age of the women was 26 y, 30% were underweight, and < 10% were nulliparous. The groups were similar for most baseline characteristics. The mean 6 SD duration of the preconception intervention was 33 6 25 wk and compliance was high (> 90%). Infants born to the 3 groups of women did not differ (P≥ 0.05) onmean6 SD birth weight (3076.8 6 444.5 g) or gestational age (39.26 2.0wk), or prevalence of SGA (12%), low birth weight (5%) and preterm delivery (10%). Therewere no significant differences in women who consumed supplements ≥26 wk before conception or by baseline underweight or anemia. Conclusion: Weekly supplementation with MMs or IFA before conception did not affect birth outcomes compared with FA in rural Vietnamese women. © 2016 American Society for Nutrition. Source

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